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2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth

Stefano Negrini123*, Angelo G Aulisa4, Lorenzo Aulisa5, Alin B Circo6, Jean Claude de Mauroy7, Jacek Durmala8, Theodoros B Grivas9, Patrick Knott10, Tomasz Kotwicki11, Toru Maruyama12, Silvia Minozzi13, Joseph P O'Brien14, Dimitris Papadopoulos15, Manuel Rigo16, Charles H Rivard6, Michele Romano3, James H Wynne17, Monica Villagrasa16, Hans-Rudolf Weiss18 and Fabio Zaina3

Author Affiliations

1 Physical and Rehabilitation Medicine, University of Brescia, Italy

2 Don Gnocchi Foundation, Milan, Italy

3 ISICO (Italian Scientific Spine Institute), Milan, Italy

4 Orthopaedics and Traumatology Division, Bambino Gesù Children's Hospital, Institute of Scientific Research, Piazza San Onofrio 4, 00165, Rome, Italy

5 Department of Orthopaedics, Catholic University of the Sacred Heart, University Hospital 'Agostino Gemelli', L.go F. Vito, 1-00168 Rome, Italy

6 Sainte Justine Hospital, University of Montreal, Canada

7 Clinique du Parc, Lyon, France

8 Department of Rehabilitation, Medical University of Silesia and University Hospital, Katowice, Poland

9 Department of Trauma and Orthopaedics, "Tzanio" General Hospital, Tzani and Afendouli 1 st, Piraeus 18536, Greece

10 Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, 60064, USA

11 Spine Disorders Unit, Department of Pediatric Orthopedics and Traumatology, University of Medical Sciences, Poznan, Poland

12 Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, Japan

13 Cochrane Review Group on Drugs and Alcohol. Department of Epidemiology. Lazio Region. Via di Santa Costanza, 53. 00198 Rome. Italy

14 National Scoliosis Foundation, Boston, USA

15 Spondylos Laser Spine Lab, Orthopaedic Facility and Rehabilitation Center, 74, Messogion Ave, 115 27, Athens, Greece

16 Institut Elena Salvá. Vía Augusta 185. 08021 Barcelona, Spain

17 Boston Brace Co., Boston, USA

18 Gesundheitsforum Nahetal. Alzeyer Str. 23. D-55457 Gensingen, Germany

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Scoliosis 2012, 7:3  doi:10.1186/1748-7161-7-3

Published: 20 January 2012

Abstract

Background

The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), that produced its first Guidelines in 2005, felt the need to revise them and increase their scientific quality. The aim is to offer to all professionals and their patients an evidence-based updated review of the actual evidence on conservative treatment of idiopathic scoliosis (CTIS).

Methods

All types of professionals (specialty physicians, and allied health professionals) engaged in CTIS have been involved together with a methodologist and a patient representative. A review of all the relevant literature and of the existing Guidelines have been performed. Documents, recommendations, and practical approach flow charts have been developed according to a Delphi procedure. A methodological and practical review has been made, and a final Consensus Session was held during the 2011 Barcelona SOSORT Meeting.

Results

The contents of the document are: methodology; generalities on idiopathic scoliosis; approach to CTIS in different patients, with practical flow-charts; literature review and recommendations on assessment, bracing, physiotherapy, Physiotherapeutic Specific Exercises (PSE) and other CTIS. Sixty-five recommendations have been given, divided in the following topics: Bracing (20 recommendations), PSE to prevent scoliosis progression during growth (8), PSE during brace treatment and surgical therapy (5), Other conservative treatments (3), Respiratory function and exercises (3), Sports activities (6), Assessment (20). No recommendations reached a Strength of Evidence level I; 2 were level II; 7 level III; and 20 level IV; through the Consensus procedure 26 reached level V and 10 level VI. The Strength of Recommendations was Grade A for 13, B for 49 and C for 3; none had grade D.

Conclusion

These Guidelines have been a big effort of SOSORT to paint the actual situation of CTIS, starting from the evidence, and filling all the gray areas using a scientific method. According to results, it is possible to understand the lack of research in general on CTIS. SOSORT invites researchers to join, and clinicians to develop good research strategies to allow in the future to support or refute these recommendations according to new and stronger evidence.